April 23, 2008

Mayo Clinic.com

Narcissistic personality disorder
December 19, 2005


Narcissistic personality disorder is a serious emotional disturbance characterized by a grandiose, or extremely exaggerated, sense of self-importance. Individuals with this disorder lack empathy for other people but need constant admiration from them.

Narcissistic personality disorder is one of several types of personality disorders, all of which reflect an inability in the affected person to accept the demands and limitations of the world. These disorders may regularly interfere with a person's behavior and interactions with family, friends or co-workers. Among the other personality disorders are paranoid personality disorder, antisocial personality disorder, borderline personality disorder and obsessive-compulsive personality disorder.

Although people with narcissistic personality disorder have an exaggerated image of their own importance, they have vulnerable self-esteems and often don't like themselves. Therefore, they seek attention that confirms their grandiosity. When feedback doesn't validate their exaggerated image, they tend to lash out or withdraw.

Narcissistic personality disorder, which is less common than other personality disorders, is estimated to affect less than 1 percent of the general population. Some studies indicate that it's more common among men. The primary treatment is psychotherapy.

Signs and symptoms

Narcissism itself is a personality trait, a much higher regard for and love of oneself than for others. The word "narcissism" comes from a character in Greek mythology. Narcissus, a handsome youth, doesn't think any of his female suitors are worthy of his beauty. When the gods condemn him to look at his reflection in a pool, he stares at himself lovingly for so long that eventually he simply withers away and dies.

Most specialists think of narcissism as lying along a continuum, from people with good psychological health to those with narcissistic personality disorder.

People who have a narcissistic personality style rather than narcissistic personality disorder are generally psychologically healthy, but may at times be arrogant, proud, shrewd, confident, self-centered and determined to be at the top. They do not, however, have an unrealistic image of their skills and worth and are not dependent on praise to sustain a healthy self-esteem.

You may find these individuals unpleasant or overbearing in certain social, professional or interpersonal encounters, but they aren't necessarily unhealthy.

Pathological narcissism

The other end of the continuum — narcissistic personality disorder — is a persistent inability to establish a realistic, stable self-image, therefore creating an overdependence on others to regulate their self-esteem. This unrealistic self-image affects how people with this disorder behave and interact with others.

Signs and symptoms of narcissistic personality disorder may include:

Grandiose sense of one's own abilities or achievements
Fantasies about having exceptional power, attractiveness or success
Sense of belonging to an exclusive group of people who truly understand each other
Need for constant praise
Expectations of special treatment
Exploitation of other people
Lack of empathy for other people
Envy of other people or a belief that you are the subject of other people's envy
Haughty or arrogant behaviors

Individuals with narcissistic personality disorder may come across as conceited or snobbish. They often monopolize conversation. They may belittle or look down on people they perceive as inferior. When they don't receive the special treatment to which they feel entitled, they may become very impatient or angry.

People with narcissistic personality disorder tend to seek out individuals whom they perceive as equal to their own self-image or to whom they attribute the same special talents and qualities they see in themselves. They may insist on having "the best" of everything — car, athletic club or social circles.

Their personal relationships and interactions are driven by the need for admiration and praise. Consequently, people with narcissistic personality disorder value others primarily according to how well those individuals affirm their unrealistic self-image. This limited value of others usually means that people with the disorder aren't interested in or aren't capable of perceiving the feelings or needs of others. They may take advantage of other people to make themselves look as good as they imagine.

On the other hand, seeking admiration also makes people with narcissistic personality disorder vulnerable to criticism. If someone criticizes an individual's contribution to a project at work, for example, he or she will perceive this comment as an assault on an image that needs to be protected at all costs and may respond with feelings of shame, humiliation or sadness or may express rage, disdain or defensive behaviors.

The shy narcissist

Some specialists have described individuals diagnosed with narcissistic personality disorder as "shy narcissists," "closet narcissists" or "deflated narcissists."

These individuals, like others with narcissistic personality disorder, have a grandiose, unrealistic sense of their abilities, achievements and worth, and they often feel disdain for others whom they perceive as less exceptional. They also have vulnerable self-esteems and are very sensitive to criticism. However, these individuals don't seek admiration or overtly express their sense of superiority.

More research is needed to determine whether "shy narcissism" is indeed a subtype of narcissistic personality disorder.


The exact cause of narcissistic personality disorder is unknown. Researchers have identified childhood developmental factors and parenting behaviors that may contribute to the disorder:

An oversensitive temperament at birth
Overindulgence and overvaluation by parents
Valued by parents as a means to regulate their own self-esteem
Excessive admiration that is never balanced with realistic feedback
Unpredictable or unreliable caregiving from parents
Severe emotional abuse in childhood
Being praised for perceived exceptional looks or talents by adults
Learning manipulative behaviors from parents
When to seek medical advice

People with narcissistic personality disorder may have other psychological impairments, such as bipolar disorder or depressive disorder. They may also have:

Suicidal thoughts
Impaired interpersonal and familial relationships
Chronic dysphoria (feeling unwell or unhappy)
Emotionally abusive behaviors
If you're thinking of hurting yourself, seek help at an emergency room. If you're having relationship or work conflicts, feelings of depression, or other feelings that disrupt your ability to function well, see your doctor to find the underlying cause and to seek treatment.

If a friend or family member exhibits persistent narcissistic behaviors that disrupt work or relationships, you might suggest that the person see a doctor to discuss how to cope more effectively with criticism or emotional problems. It's unlikely, however, that you'll be able to convince a person with narcissistic personality disorder to seek help to correct the narcissistic behaviors or the person's unrealistic self-image.

Screening and diagnosis

A diagnosis is most often made by a psychotherapist — usually a psychiatrist, psychologist or licensed clinical social worker. In addition to interviewing an individual who may have narcissistic personality disorder, the psychotherapist may depend on observations, psychological tests and interviews with significant others in order to make assessments. They will make a diagnosis of narcissistic personality disorder if there is evidence of five or more of the following nine features:

Grandiose self-image
Fantasies about having exceptional qualities
Sense of being so special that only other special people can understand or relate to the individual
Need for excessive admiration
Sense of entitlement
Exploitation of other people
Lack of empathy
Envy of other people or a belief that you are the subject of other people's envy
Arrogant behaviors or attitudes

Most specialists agree that grandiosity is the central feature that distinguishes narcissistic personality disorder from related disorders that share some of the same symptoms. A diagnosis also depends on the presence of these features in an ongoing pattern since early adulthood and in a variety of contexts.

The disorder is almost never diagnosed in adolescents. Although teenagers may exhibit narcissistic personality traits, these features are usually corrected by experiences that influence adult personality development.


Treatment for narcissistic personality disorder is generally a difficult, long-term process. The therapist needs time to diagnose the disorder, to understand how it is manifested and to address the narcissistic behaviors. Individual psychotherapy is the most common treatment approach, but some therapists may also integrate group and family therapy.

People with narcissistic personality disorder may be defensive about the process because they were compelled or encouraged to seek therapy by an employer or family member. They may have sought treatment to address a related problem, such as depression or a job crisis, but are unwilling to address the underlying disorder identified by the therapist.

Most people with narcissistic personality disorder are not amenable to the therapist-client relationship or to therapists' questions or comments. They're likely to engage with the therapist in their normal manner of portraying a grandiose image and seeking affirmation. When the therapist questions the reality of that self-image or problems with particular behaviors, the individual may react defensively, devalue the skill of the therapist or discontinue treatment.

The short-term goal of psychotherapy is to address symptoms, such as depression or shame, that result from attacks on self-esteem. The long-term goal is to reshape the personality to some degree, so that the person can change thinking that distorts self-image, construct a realistic self-image, regulate a stable self-esteem and engage empathetically with others.

Medication use is limited, but a doctor may recommend drugs to treat related symptoms, such as depression or anxiety.


The Mayo Clinic

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